Kembral L Nelson1, Lindsey L Locke, Leslie N Rhodes, William A Mabry, Jeffrey R Sawyer, William C Warner, Tamekia Jones, David D Spence, Derek M Kelly. 1. Kembral L. Nelson, PharmD, Clinical Pharmacist, Nationwide Children's Hospital, Columbus, OH. Lindsey L. Locke, MSN, CPNP-BC, Pediatric Orthopedic Nurse Practitioner, Le Bonheur Children's Hospital, Memphis, TN. Leslie N. Rhodes, DNP, PPCNP-BC, Pediatric Orthopedic Nurse Practitioner, Neuromuscular Clinic; Assistant Professor, University of Tennessee Health Science Center; College of Nursing-Health Promotion and Disease Prevention; LeBonheur Children's Hospital. William A. Mabry, PharmD, MBA, Medication Safety Pharmacist, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, TN. Jeffrey R. Sawyer, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. William C. Warner, Jr., MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Tamekia Jones, PhD, Statistician, Associate Professor, Children's Foundation Research Institute, Memphis, TN; and Department of Pediatrics and Preventive Medicine, The University of Tennessee, Memphis, TN. David D. Spence, MD, Orthopedic Surgeon, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Derek M. Kelly, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN.
Abstract
BACKGROUND: Standardized pathways decrease variability and improve outcomes and safety. PURPOSE: The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference. METHODS: A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10-21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001. RESULTS: The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group. CONCLUSION: The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.
BACKGROUND: Standardized pathways decrease variability and improve outcomes and safety. PURPOSE: The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference. METHODS: A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10-21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001. RESULTS: The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group. CONCLUSION: The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.